含不同脂肪乳剂的肠外营养对肝移植大鼠肝脏功能的影响

目的　研究含不同脂肪乳剂的肠外营养 (TPN)对肝移植大鼠肝脏功能的影响。方法　建立肝移植大鼠模型 ,按照提供的能源不同分为单糖 (GLU )、脂肪乳剂MCT/LCT、LCT、STG 4个组 ,实验期为 7d ,记录实验期内动物死亡情况 ,于TPN后第 1、4、7d收集标本 ,检测AKBR(动脉血酮体比值 )、血ALT、AST、血TBIL。以正常和肝移植大鼠作为对照。结果　单糖组 7d动物死亡率显著高于脂肪乳剂组 (5 0 %vs0 % )。与脂肪乳组相比 ,单糖组动物 7d内血清ALT和AST水平降低缓慢、TBIL水平持续显著升高 ,AKBR水平在TPN后 1d恢复并稳定于较高水平 ,但于 7d时显著降低。在 1、4d时STG组动物血清ALT降低较MCT/LCTTPN组及LCTTPN组更为显著 ,MCT/LCTTPN组血清ALT水平低于LCTTPN组。结论　单糖TPN加重移植肝脏功能损害 ,动物死亡率增高 ,含脂肪乳的TPN能促进移植肝功能恢复。在减轻移植肝功能损害方面的优越性 ,依次为STG、MCT/LCT和LCT。

Influence of total parenteral nutrition containing different fat emulsion on hepatic function in rats after liver transplantation

Objective To study the influence of glucose with different kinds of fat emulsions or without fat emulsion on hepatic function after liver transplantation in rats. Methods A model of TPN in rats with liver transplantation with modified tube and retainer was established. Seventy two rats after liver transplantation were assigned to four groups containing 18 pairs of rats each according to the different energy sources. Rats in MCT/LCT group were given MCT/LCT and glucose. Group STG and LCT received STG plus glucose and LCT plus glucose, respectively. Glucose was the only energy source in Group GLU. The specimen of blood was obtained on day 1, 4, and 7 after TPN. AKBR, serum ALT, AST, and TBIL were determined. Animal survival was recorded during the experimental period. Results Compared with other groups, serum ALT and AST levels in Group GLU were decreased slowly. While TBIL level was elevated gradually. Though AKBR was increased on day 1 after TPN, it declined gradually and was significantly lower than that in normal control group on day 7. Mortality rate of rats in GLU group was 50% during the experimental period. In the three fat emulsions groups, the serum ALT, AST, TBIL and AKBR recovered to normal level 7 days after TPN. No animal death due to TPN was found in fat emulsion groups. Serum levels of ALT and AST in Group STG were more significantly lower than those in Group MCT/LCT. ALT and AST in Group MCT/LCT were significantly decreased when compared with Group LCT, especially during the early period of TPN. Conclusions TPN containing fat emulsion is safe and effective in rats with liver transplantation, and STG seems to be the best choice of fat emulsion, while TPN with kilocalorie supplemented by GLU only is not helpful for improving liver function.